Tibial nerve dysfunction

Definition

Tibial nerve dysfunction is a loss of movement or sensation in the foot from damage to the tibial nerve.

Alternative Names

Neuropathy - posterior tibial nerve; Tarsal tunnel syndrome

Causes

Tibial nerve dysfunction is an unusual form of peripheral neuropathy. It occurs when there is damage to the tibial nerve, one of the lower branches of the sciatic nerve of the leg. The tibial nerve supplies movement and sensation to the calf and foot muscles.

A problem in function with a single nerve group, such as the tibial nerve, is called mononeuropathy. The usual causes are:

Direct trauma

Pressure on the nerve for a long period of time

Pressure on the nerve from nearby body structures

Entrapment createes pressure on the nerve where it passes through a narrow structure.

The damage may destroy the myelin sheath that protects and insulates the nerve, or part of the nerve cell (the axon). This damage reduces or prevents the movement of impulses through the nerve.

The tibial nerve is often injured by pressure from a ligament on the inner part of the ankle. Injury or disease of structures near the knee may also damage the tibial nerve. The tibial nerve may also be affected by diseases that damage many nerves, such as diabetes.

Treatment

Treatment is aimed at restoring feeling and strength to the foot and toes. In some cases, no treatment is needed, and patients will recover on their own. Severe loss of sensation may lead to toe or foot sores (ulcers) and infections.

Surgery to enlarge the tarsal tunnel will reduce pressure on the tibial nerve and may benefit some people.

Phenytoin, carbamazepine, gabapentin, pregabalin, duloxetine, or tricyclic antidepressants such as nortriptyline may reduce the stabbing pains that some people experience.

Opiate pain relievers, such as morphine or fentanyl, may be needed to control severe pain.

Whenever possible, medication should be avoided or reduced to lessen the risk of side effects.

Physical therapy exercises may help some people maintain muscle strength.

Job counseling, therapy, changes, or retraining may be recommended.

Outlook (Prognosis)

If the cause of the tibial nerve dysfunction can be found and successfully treated, patients can recover fully. Some people may have a partial or complete loss of movement or sensation. Nerve pain may be uncomfortable and last for a long period of time.

Possible Complications

Deformity of the foot (mild to severe)

Movement loss in the toes (partial or complete)

Repeated or unnoticed injury to the leg

Sensation loss in the toes or foot (partial or complete)

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms of tibial nerve dysfunction are present. Early diagnosis and treatment increases the likelihood that symptoms can be controlled.